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Temporary transvenous cardiac pacing in cathlab - myocardial infarction versus other causes - differences,
Tomasz Skowerski1, Andrzej Kułach2, Michał Kucio2
1Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland. tskowerski@gmail.com.
Insights
Transvenous temporary cardiac pacing (TTCP) is vital, but outcomes vary by cause. Myocardial infarction (MI) patients needing TTCP face higher mortality, not due to pacing complications, but MI severity.
Area of Science:
- Cardiology
- Interventional Cardiology
- Critical Care Medicine
Background:
- Transvenous temporary cardiac pacing (TTCP) is a critical intervention for bradycardia.
- Prognosis and complication rates of TTCP are influenced by the underlying etiology.
- Comparing outcomes in myocardial infarction (MI) versus non-MI patients undergoing TTCP is essential.
Purpose of the Study:
- To compare characteristics, complications, and prognosis of patients undergoing TTCP for MI versus other causes of bradycardia.
- To identify factors contributing to mortality in patients requiring TTCP.
- To evaluate the safety and efficacy of TTCP in different patient populations.
Main Methods:
- A retrospective analysis of 244 patients undergoing TTCP between 2017 and 2021.
- Patients were categorized into myocardial infarction (MI) group (n=113) and non-MI control group.
- Data collected included patient demographics, procedural details, complications, and in-hospital outcomes.
Main Results:
- MI patients requiring TTCP were younger, with higher rates of hypertension and heart failure.
- Pacing leads were more often placed during asystole/resuscitation in MI patients, with longer pacing duration.
- In-hospital mortality was 6.5-fold higher in MI patients (OR 8.1), though TTCP complication rates were similar.
- Cardiac implantable electronic device implantation was less frequent in MI patients (22% vs 82%).
Conclusions:
- In-hospital mortality is significantly higher for MI patients requiring TTCP compared to non-MI patients.
- The increased mortality is attributed to MI severity and emergent pacing, not TTCP complications.
- TTCP complication rates are comparable between MI and non-MI groups, highlighting its safety profile.
Background:
Transvenous temporary cardiac pacing (TTCP) is a lifesaving procedure, but the incidence of complications and prognosis depends on the underlying cause. The aim of this study was to compare the characteristics, complications, and prognosis in patients with myocardial infarction (MI) requiring TTCP vs. patients with TTCP due to other causes.
Methods:
The present analysis involved 244 cases in whom TTCP was performed between 2017 and 2021 in a high-volume cathlab. All the procedures were performed by an interventional cardiologist. MI constituted 46.3% of the patients (n = 113), including 63 ST-segment elevation MI patients (55.75%). Non-MI patients (control group) consisted of patients with any cause of bradycardia requiring TTCP.
Results:
Myocardial infarction patients requiring TTCP are younger and have a higher prevalence of hypertension and heart failure. The pacing lead is more frequently inserted during asystole/resuscitation, and pacing was needed for a longer time. MI patients required cardiac implantable electronic device implantation less frequently than in other causes (22% vs. 82%, p < 0.01). The incidence of TTCP complications did not differ. The incidence of in-hospital death was 6.5-fold higher in TTCP patients with MI. Logistic regression showed MI to be a strong predictor of in-hospital death (odds ratio: 8.1; 95% confidence interval: 1.3-57.9).
Conclusions:
In-hospital mortality in MI patients requiring TTCP is 6.5-fold higher than in other patients with bradycardia. The complication rate of TTCP is similar in MI and non-MI patients. It is not TTCP but the severity of MI itself and the fact that a pacing lead is frequently implanted in asystole or during resuscitation that is responsible for the higher mortality rate.
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